Psoriasis is a common autoimmune disorder that causes red, thick, inflamed patches of skin. The patches are often covered in whitish silvery scales called plaques. In some cases, the affected skin will crack, bleed, or ooze. Many people feel burning, pain, and tenderness around the affected skin.

Psoriasis is a chronic condition. Even with treatment, psoriasis will never fully go away. Therefore, treatment aims to reduce symptoms and to help the disease enter remission. Remission is a period of little to no disease activity. This means there are fewer symptoms.

There are a range of treatment options available for psoriasis, including oral medications. Oral drugs are a form of systemic treatment, which means they affect your whole body. These drugs can be very strong, so doctors typically only prescribe them for severe psoriasis. In many cases, these drugs are reserved for people who haven’t had much success with other psoriasis treatments. Unfortunately, they can cause a variety of side effects and issues.

Read on to learn more about the most common oral medications and their side effects and risks.

Acitretin (Soriatane) is an oral retinoid. Retinoids are a form of vitamin A. Acitretin is the only oral retinoid used to treat severe psoriasis in adults. It can cause serious side effects. Because of this, your doctor may only prescribe this medication for a short time. When your psoriasis enters remission, your doctor may advise you to stop taking this drug until you have another flare-up.

Side effects of acitretin

The more common side effects of acitretin include:

chapped skin and lips

hair loss

dry mouth

aggressive thoughts

changes in your mood and behavior

depression

headache

pain behind your eyes

joint pain

liver damage

In rare cases, serious side effects can occur. Call your doctor right away if you experience any of the following:

a change in vision or a loss of night vision

bad headaches

nausea

shortness of breath

swelling

chest pain

weakness

trouble speaking

yellowing of your skin or the whites of your eyes

Pregnancy and acitretin

Be sure to discuss your reproductive plans with your doctor before you begin taking acitretin. This drug can cause problems with some birth control methods. You shouldn’t take acitretin if you’re pregnant or planning to become pregnant. After stopping acitretin, you shouldn’t become pregnant for the next three years.

If you’re a woman who could become pregnant, you shouldn’t drink alcohol while taking this medication and for two months after you stop taking it. Combining acitretin with alcohol leaves behind a harmful substance in your body. This substance could fatally harm future pregnancies. This effect lasts for up to three years after you finish treatment.

Cyclosporine is an immunosuppressant. It’s available as the brand-name medications Neoral, Gengraf, and Sandimmune. It’s used to treat severe psoriasis if other treatments don’t work.

Cyclosporine works by calming the immune system. It prevents or stops the overreaction in the body that causes symptoms of psoriasis. This drug is very strong and can cause serious side effects.

Side effects of cyclosporine

The more common side effects of cyclosporine include:

headache

fever

stomach pain

nausea

vomiting

unwanted hair growth

diarrhea

shortness of breath

slow or fast heart rate

changes in urine

back pain

swelling of your hands and feet

unusual bruising or bleeding

excessive tiredness

excessive weakness

increased blood pressure

shaky hands (tremor)

Other risks of cyclosporine

Cyclosporine can cause other problems as well. These include:

Drug interactions. Some versions of cyclosporine can’t be used at the same time or after other psoriasis treatments. Tell your doctor about every drug or treatment you’ve ever taken and are currently taking. This includes medications to treat psoriasis, as well as treatments for other conditions. If you have trouble remembering which drugs you’ve taken, which many people do, ask your pharmacist for a list of those medications.

Kidney damage. Your doctor will check your blood pressure before and during your treatment with this drug. You’ll likely also need to have regular urine tests. This is so your doctor can check for possible kidney damage. Your doctor may pause or stop your treatment with cyclosporine to protect your kidneys.

Infections. Cyclosporine raises your risk of infections. You should avoid being around sick people so you don’t pick up their germs. Wash your hands often. If you have signs of an infection, call your doctor right away.

Nervous system problems. This drug can also cause nervous system problems. Tell your doctor right away if you have any of these symptoms:

Methotrexate (Trexall) belongs to a drug class called antimetabolites. This drug is given to people with severe psoriasis who have not had much success with other treatments. It can slow the growth of skin cells and stop scales from forming.

Side effects of methotrexate

The more common side effects of methotrexate include:

tiredness

chills

fever

nausea

stomach pain

dizziness

hair loss

eye redness

headaches

tender gums

loss of appetite

infections

Your doctor may recommend a folic acid (vitamin B) supplement to help protect against some of these side effects.

In rare cases, this medication can cause serious, life-threatening side effects. The risk of having these side effects increases with higher doses of the medication. Call your doctor right away if you experience any of the following:

unusual bleeding

yellowing of your skin or whites of your eyes

dark-colored urine or blood in your urine

dry cough that doesn’t produce phlegm

allergic reactions, which may include trouble breathing, rash, or hives

Other risks of methotrexate

Methotrexate can cause other problems as well. These include:

Drug interactions. You shouldn’t combine this drug with certain other drugs due to the risk of serious side effects. These may include anti-inflammatory drugs that are available over the counter. Talk to your doctor about other serious interactions that could occur if you take certain medications.

Liver damage. If this drug is taken for a long time, it can cause liver damage. You shouldn’t take methotrexate if you have liver damage or a history of alcohol abuse or alcoholic liver disease. Your doctor may recommend a liver biopsy to check for liver damage.

Effects with kidney disease. Talk to your doctor before taking this drug if you have kidney disease. You may need a different dosage.

Harm to pregnancy. Women who are pregnant, breastfeeding, or planning to become pregnant shouldn’t use this drug. Men should not get a woman pregnant during treatment and for three months after stopping this drug. Men should use condoms throughout this time.

In 2014, the U.S. Food and Drug Administration (FDA) approved apremilast (Otezla) to treat psoriasis and psoriatic arthritis in adults. Apremilast is thought to work within your immune system and decrease your body’s response to inflammation.

Side effects of apremilast

According to the FDA, the more common side effects people experienced during clinical trials included:

headache

nausea

diarrhea

vomiting

cold symptoms, such as a runny nose

stomach pain

People who were taking this drug also reported depression more frequently during clinical trials than people taking a placebo.

Effects with kidney disease. Talk to your doctor before taking this drug if you have kidney disease. You may need a different dosage.

Drug interactions. You shouldn’t combine apremilast with some other drugs, because they make apremilast less effective. Examples of these drugs include the seizure medications carbamazepine, phenytoin, and phenobarbital. Talk to your doctor about other medications you’re taking before you start apremilast.

Systemic treatments also include injected prescription drugs. As with oral drugs, injected drugs called biologics work throughout your entire body to slow the disease’s progress. Still other treatments include light therapy and topical medications.

Biologics

Some injected drugs alter the immune system. These are known as biologics. Biologics are approved for treating moderate to severe psoriasis. They’re typically used when your body hasn’t responded to traditional therapy or in people who also experience psoriatic arthritis.

Topical treatments

Topical medications are applied directly to your skin. These treatments generally work best on mild to moderate psoriasis. In more severe cases, topical treatments may be combined with oral medication or light therapy.

Common topical treatments include:

moisturizers

salicylic acid

coal tar

corticosteroid ointment

vitamin D analogues

retinoids

anthralin (Dritho-Scalp)

calcineurin inhibitors, such as tacrolimus (Prograf) and pimecrolimus (Elidel)

If you have psoriasis, discuss your treatment options with your doctor. As the disease progresses, you may need to change your treatment. You may need stronger treatments if the psoriasis becomes more severe or doesn’t respond to treatment. In these cases, oral medications may be a good option.

Also talk with your doctor about how these medications may affect you. Work with your doctor to find the treatments that help relieve your psoriasis symptoms without causing unpleasant side effects.